Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May:54:93-105.
doi: 10.1016/j.gaitpost.2017.02.024. Epub 2017 Feb 24.

Effectiveness of surgical and non-surgical management of crouch gait in cerebral palsy: A systematic review

Scott A Galey  1 , Zachary F Lerner  2 , Thomas C Bulea  2 , Seymour Zimbler  3 , Diane L Damiano  4
Affiliations

Effectiveness of surgical and non-surgical management of crouch gait in cerebral palsy: A systematic review

Scott A Galey et al. Gait Posture. 2017 May.

Abstract

Background: Cerebral palsy (CP) is a prevalent group of neuromotor disorders caused by early injury to brain regions or pathways that control movement. Patients with CP exhibit a range of functional motor disabilities and pathologic gait patterns. Crouch gait, characterized by increased knee flexion throughout stance, is a common gait pattern in CP that increases energy costs of walking and contributes to ambulatory decline. Our aim was to perform the first systematic literature review on the effectiveness of interventions utilized to ameliorate crouch gait in CP.

Methods: Comprehensive searches of five medical databases yielded 38 papers with 30 focused on orthopaedic management.

Results: Evidence supports the use of initial hamstring lengthenings and rectus femoris transfers, where indicated, for improving objective gait measures with limited data on improving gait speed or gross motor function. In contrast, evidence argues against hamstring transfers and revision hamstring lengthening, with recent interest in more technically demanding corrective procedures. Only eight studies evaluated alternatives to surgery, specifically strength training, botulinum toxin or orthoses, with inconsistent and/or short-lived results.

Conclusions: Although crouch in CP is recognized clinically as a complex multi-joint, multi-planar gait disorder, this review largely failed to identify interventions beyond those which directly address sagittal plane knee motion, indicating a major knowledge gap. Quality of existing data was notably weak, with few studies properly controlled or adequately sized. Outcomes from specific procedures are confounded by multilevel surgeries. Successful longer term strategies to prevent worsening of crouch and subsequent functional decline are needed.

Level of evidence: Systematic review.

Keywords: Cerebral palsy; Crouch gait; Hamstring lengthening; Knee flexion; Pediatric orthopedics.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1.
Fig. 1.
Systematic search and review strategy and results.
See this image and copyright information in PMC

References

    1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B, A report: the definition and classification of cerebral palsy April 2006, Dev. Med. Child Neurol. Suppl 109 (2007) 8–14. - PubMed
    1. Wren TAL, Rethlefsen SP, Kay RM, Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery, J. Pediatr. Orthop 25 (2005) 79–83. - PubMed
    1. Hicks JL, Schwartz MH, Arnold AS, Delp SL, Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait, J. Biomech 41 (2008) 960–967, doi:10.1016/j.jbiomech.2008.01.002. - DOI - PMC - PubMed
    1. Steele KM, Seth A, Hicks JL, Schwartz MS, Delp SL, Muscle contributions to support and progression during single-limb stance in crouch gait, J. Biomech 43 (2010) 2099–2105, doi:10.1016/j.jbiomech.2010.04.003. - DOI - PMC - PubMed
    1. Waters RL, Mulroy S, The energy expenditure of normal and pathologic gait, Gait Posture 9 (1999) 207–231, doi:10.1016/S0966-6362(99)00009-0. - DOI - PubMed

Publication types

MeSH terms

Substances